If you have kidney cancer, you are likely to undergo a type of surgery called nephrectomy. Read about the different approaches and how to prepare.

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A surgical procedure known as nephrectomy is a
common form of kidney
cancer treatment
used to remove all or
part of a kidney that has become cancerous.

"Typically, the [blood] vessels are clamped
and the kidney is taken out in part or total, depending on the tumor," explains Toni K. Choueiri, MD, an instructor in
the department of medicine at Harvard Medical School and an attending physician
in solid tumor oncology at Dana-Farber Cancer Institute in Boston.

Nephrectomy can often be performed as a “partial
nephrectomy,” where only a portion of the affected kidney is removed. This is
more likely to be possible if the cancer is small and easily removable. But for
larger cancers, a “radical nephrectomy” may need to be performed. During a
radical nephrectomy, the entire kidney, including surrounding fatty tissue,
lymph nodes, and the adrenal gland are removed.

If possible, your surgeon will try to take only
part of the affected kidney using laparoscopic surgery. "Not everyone
needs a radical nephrectomy," Dr. Choueiri says. "We now know a
partial nephrectomy should be the preferred surgery."

Preparing
for Nephrectomy

There are steps you should take to prepare for a
nephrectomy for kidney
cancer, Choueiri says. These include:

Get into the habit of
drinking plenty of water. "It's very important [that patients] acknowledge
they're going to lose one kidney," Choueiri says. By drinking lots of
water, the patient will help keep their remaining kidney healthy and flush out any
impurities that can lead to kidney damage or problems like kidney stones.

Avoid unnecessary nephrotoxic
drugs — those that can that can cause damage to the kidneys. These
include some blood pressure medications, proton pump inhibitors, and non-steroidal
anti-inflammatory drugs (NSAIDs). Make sure that your doctor is aware of every
drug you take, and do not make medication changes without discussing them with
your practitioner.

If you are on blood-thinning
medications like anticoagulants, or anti-platelet drugs like aspirin, discuss
the situation with both your oncologist and your surgeon. These drugs will need
to be stopped so that they don’t cause bleeding problems during surgery. Your
oncologist or medical doctor will need to coordinate these medication changes
with your surgeon.

Laparoscopic nephrectomy. This
is a minimally invasive procedure performed using several small incisions.
Doctors insert a small video camera and specialized long instruments through
the incisions and work inside the body to remove part, or all, of the kidney.
This has become the preferred method for removing kidney cancer tumors, as it
causes less pain and patients heal more quickly. If a patient can have
laparoscopic surgery, “the advantage is perhaps less hospital stay,"
Choueiri says. "You save a day or two."

Open nephrectomy. This
surgery involves removing the kidney through a larger four- or five-inch
incision made in the upper back, the abdomen, or along the flank. Surgeons may
need to remove a rib to perform the procedure.

Possible
Complications of Kidney Cancer Surgery and Aftercare

Kidney cancer surgery comes with a set of risks you
should understand beforehand. They include:

Excessive bleeding that
could require a blood transfusion

Post-operative infection
of your surgical incisions

Damage to blood vessels
and internal organs during surgery

Developing a weakening of
the abdominal wall — called a hernia — caused by problems
with incision healing

Kidney failure

Right after your surgery
is completed, doctors
and nurses will carefully monitor bodily functions linked to the kidneys such
as electrolyte (salt) balance, fluid balance, and blood pressure. You might
feel pain or numbness around your incisions, and you might be given pain
killers to help during recovery. You’ll probably have a urinary catheter
inserted for a short time while you recover.

After surgery you might feel pain
whenever you breathe deeply or cough, since the incision is likely to be near
your diaphragm. Although it may be painful, your medical team might ask you to
perform breathing exercises to help head off pneumonia.

Your hospital stay will be one to seven days,
depending on what type of nephrectomy you had. You should avoid heavy lifting
and strenuous activity for at least six weeks following the surgery, but will
be able to return to light activity as soon as you feel ready.

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